Penetrating Trauma and Gunshot Wounds

Penetrating Trauma

Classified as low energy, medium energy, or high energy
Low energy: accidentally caused by impalement or intentionally by a knife, ice pick, or other type of weapon
High energy: Point Blank and high velocity gunshot wounds, resulting in more significant injuries

Gunshot Wounds

The body area involved can be estimated by looking at the location of entrance and the length of the weapon
Angle and direction of travel are important in determining the internal organs injured
Internal organs injured may have no relationship to the entrance and exit wounds
Determining the number of penetrating injuries and combining that information with the potential pathway is crucial

Bullet Types

Fragible bullets: increase damage due to multiple fragments, causing more damage
Full Metal Jacket bullets: cause less damage than fragmented rounds because they don't fragment and expand in the same way

Bullet Speed and Injury Pattern

Bullet speed is a major factor in the resulting injury pattern
Cavitation results from rapid changes in tissue and fluid pressure caused by the passage of the projectile
Temporary cavity is produced by stretching tissue surrounding the point of impact
Permanent cavitation injury results closer to the bullet path where pressure fluctuations are greatest

Air Resistance and Distance

Air resistance (drag) slows the projectile, decreasing the depth of penetration and energy, and reducing tissue damage
Distance and severity of injury vary depending on the type of weapon used

Blast Injuries

Classified into primary, secondary, tertiary, and miscellaneous blast injuries
Primary blast injuries: entirely due to the blast itself, damaging compressible structures like lungs and eardrums
Secondary blast injuries: result from being struck by flying debris, causing blunt and penetrating injuries
Tertiary blast injuries: occur when a person is hurled by the force of the explosion against stationary objects
Miscellaneous blast injuries: result from miscellaneous events that occur during the explosion, like heat-generated burns

Multi-Stem Trauma

Occurs when a person is subjected to multiple traumatic injuries involving more than one body system
Patients have a high morbidity and mortality rate
Golden principles of prehospital trauma care: ensure safety, determine the need for additional personnel or equipment, and identify and manage life threats

Head and Neck Injuries

May result in unseen injuries to the brain
Bleeding or swelling inside the skull from brain injury is often lifethreatening
Neurologic assessments coupled with the patient's level of consciousness provide details on subtle changes in the patient's condition
Injuries to the neck and throat may result in airway problems
Use an occlusive dressing on any neck wound to prevent air from entering the circulation or airway

Chest Trauma

May fracture ribs or the sternum, causing air to collect in the chest cavity and compressing lung tissues
Large vessels of the heart may be torn, leading to cardiac tamponade
Hemothorax occurs when blood collects within the chest cavity

Abdominal Trauma

Solid organs may tear, lacerate, or fracture
Hollow organs may rupture, causing toxic fluids to leak
Healthy young adults can compensate longer than others for blood loss, but a high index of suspicion should be maintained

Trauma Lethal Triad

Hypothermia, coagulopathy, and acidosis are the major contributors to death in patients with severe traumatic bleeding
Factors that interfere with blood clotting can cause more blood loss
Aggressively seek to control all bleeding and do not hesitate to use a tourniquet

IV Fluid Administration

Ensure IV fluids are warmed to at least normal body temperature to prevent heat loss
Minimize the volume of acidic IV fluid administration to prevent interfering with coagulation and contributing to acidosis

Transportation

Two types: ground or air
Factors to consider when choosing transportation: extraction time, distance to a Trauma Center, need for medical care and stabilization at the advanced life support level, and hospital availability
Criteria for referral to a Trauma Center and hospital resources available in the area should be considered
Transport to the most appropriate facility based on patient injuries, with Trauma Centers classified as levels 1-4, with level 1 being the most resource-rich.

Classifying Penetrating Trauma

Classified into low energy, medium energy, or high energy based on the cause and severity of injury
Low energy injuries are caused by impalement or stabbing, while high energy injuries are caused by high-velocity gunshot wounds

Gunshot Wounds

Entrance and exit wounds can estimate the body area involved
Angle and direction of travel determine the internal organs injured
Internal organs injured may not relate to the entrance and exit wounds

Bullet Types and Injury

Fragible bullets cause more damage due to multiple fragments
Full Metal Jacket bullets cause less damage due to minimal fragmentation and expansion

Bullet Speed and Injury Pattern

Bullet speed affects the resulting injury pattern
Cavitation and temporary cavity formation occur due to rapid tissue and fluid pressure changes
Permanent cavitation injury occurs closer to the bullet path

Air Resistance and Distance

Air resistance slows the projectile, reducing penetration and tissue damage
Distance and severity of injury vary with weapon type

Blast Injuries

Classified into primary, secondary, tertiary, and miscellaneous blast injuries
Primary blast injuries damage compressible structures like lungs and eardrums
Secondary blast injuries result from flying debris, causing blunt and penetrating injuries
Tertiary blast injuries occur when a person is hurled against stationary objects
Miscellaneous blast injuries result from miscellaneous events during the explosion

Multi-Stem Trauma

Involves multiple traumatic injuries affecting more than one body system
Patients have a high morbidity and mortality rate
Golden principles of prehospital trauma care include ensuring safety and identifying life threats

Head and Neck Injuries

May result in unseen brain injuries and lifethreatening bleeding or swelling
Neurologic assessments provide details on subtle changes in patient condition
Injuries to the neck and throat may result in airway problems
Use an occlusive dressing on any neck wound to prevent air entry

Chest Trauma

May cause rib or sternum fractures, leading to air collection in the chest cavity and lung compression
Large heart vessels may tear, leading to cardiac tamponade
Hemothorax occurs when blood collects within the chest cavity

Abdominal Trauma

Solid organs may tear, lacerate, or fracture
Hollow organs may rupture, causing toxic fluid leakage
Healthy young adults can compensate longer for blood loss, but maintain a high index of suspicion

Trauma Lethal Triad

Hypothermia, coagulopathy, and acidosis contribute to death in patients with severe traumatic bleeding
Factors interfering with blood clotting can cause more blood loss
Control bleeding aggressively and consider tourniquet use

IV Fluid Administration

Warm IV fluids to at least normal body temperature to prevent heat loss
Minimize acidic IV fluid administration to prevent interference with coagulation and acidosis

Transportation

Consider extraction time, distance to a Trauma Center, and hospital availability when choosing transportation
Referral to a Trauma Center depends on patient injuries and hospital resources
Transport to the most appropriate facility based on patient injuries and Trauma Center classification